Healthcare Provider Details

I. General information

NPI: 1811320435
Provider Name (Legal Business Name): ACCESSIBLE BEHAVIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRIAN CIR
ANTIOCH TN
37013-4340
US

IV. Provider business mailing address

100 BRIAN CIR
ANTIOCH TN
37013-4340
US

V. Phone/Fax

Practice location:
  • Phone: 615-403-8206
  • Fax: 615-301-6196
Mailing address:
  • Phone: 615-403-8206
  • Fax: 615-301-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-11796
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5228
License Number StateTN

VIII. Authorized Official

Name: DR. PETER A. BEDDOW
Title or Position: PRESIDENT/OWNER
Credential: PHD
Phone: 615-403-8206